NCS01581_2022Permit_Initial

2022
Permit and Registration
Future Abode, Inc. DBA Charlotte Septic Inspections

is hereby issued a Septage Management Firm Permit,
Permit Number NCS-01581
and registered as a Septage Management Firm
(PUMPER)
in the State of North Carolina.

This permit to operate a Septage Management Firm is issued to the above named person, business or entity alone and is not transferable to any other person, business or entity. Firm operation shall be in accordance with the provisions of N.C. General Statute 130A-291.1 - 130A-291.3, Title 15A of the N.C. Administrative Code 13B .0800 et.seq., conditions of the permit, and representations made in the application and accompanying documents for a permit. The permit holder is authorized to discharge septage only at the locations(s) listed below: 1. Rocky River Regional WWTP, Concord NC
This permit does not entitle the permit holder to operate a Septage Land Application Site, a Septage Detention or Treatment Facility, or any other solid waste management facility
not specified herein. Failure to operate as permitted may result in the Department suspending or revoking this permit, initiating action to enjoin the unpermitted operation, imposing administrative penalties, or invoking any other remedy as provided in Chapter 130A, Article 1, part 2 of the North Carolina General Statutes. This permit and registration expires on December 31, 2022.

__________________________________________________ Adam Ulishney, Environmental Compliance Branch Head

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
DIVISION OF WASTE MANAGEMENT SOLIDWASTE SECTION-1646 MAIL SERVICE CENTER,RALEIGH,NC 27699.-1646
(1.) Fim name: (The "Fim name" must be exactly as it is shown on your vehicle/s).
Future Abode DOA norlotte SpticLnspectons Streel address of office: 6|| Concord Mils BlvD4
CityanCord StaleA/ZD_802
Mailing address (if different):
City State Zip
Phone Fax
EMa fLutureAtmde NCOGmal Com
Countya0ar rus Septage Management Firm permit number:NCS# OIS8|
Todd Freeberg-(2.) Firm owner's name.
Mailing address (f diferent)
City State Zip
Phone Fax
(3.) Firm operator's ame Velson hosado_Fim operator's title:
Maling address if diferent): |AutummnEcost Aue
CitySroesville
Phone 7 4 Fax:
(4.) Type(s) of septage pumped: Write in thenumber of gallons pumpedin last 12 months (Example: Domestic: 50,.000)
StateA C Zp: 8672_
Domestic Portable Toilet Waste Grease (Restaurant Treatment Plant Industrial/Commercial
(5) NG Counties of Operalipn:Catauo0, Lycoln,Gaston Lcedell Stanley
KawanVoionLabartucAandlalobAadaq e ke Mecllonburg (List each countyýou are authorized toldo búsiness in)
(6.) Total Number of Pumper Vehicles Operated:.
Number used for: Domestic Septage
Other
Vehicle Information: (use additional paper if needed)
Grease (restaurant):
Portable Toilet Waste:
License Tag # Vehicle ldentification # Tank Capacity
HTWOAANX7T 4344| 2500
APPLICATION CONTINUED ON PAGE 2
PAGE 1
APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(CONTINUED FROM PAGE 1)
(7.) Do you plan to operate pumper vehicles? (check one)(yes ()no
If you checked yes above,you must attest to the following statement before a permit may be issued.
oertify, under penalty of law, that the pumper vehicle or vehicles listed in the submitted permit application meets the
requirements for safe and sanitary transportation of septage as required by 15A NCAC 13B .0835(a) and vehicle letering
as required by 15A NCAC .0835(b). Furthermore, I also certify that a log is maintained of each septage pumping evernt as
required by 15A NCAC 13B .0836(a). l am aware that there are significant pernalties for false certification including the
possibility of fine and imprisonment."
Do you attest to the statement above?(V) yes ()no Initial N Dae_8/31/21
(8.) Septage Disposal Method: (check one)
a) Approved wastewater treatment plant: ( )yes ()no. If yes, submit Wastewater Treatment Authorization for each
plant, as indicated in Subparagraph 0834(0X14) of theSeptage Management Rules.
b) Septage Land Application Site (SLAS) Permit Numbers: (use adional sheets if needed)
SLAS# Expir ation Date: SLAS#Expiration Date:_
o) Septage Detention or Treatment Faclity (SDTF) Pemit Numbers: (use additional sheets f needed)
SDTF# Expiration Date:_SDTF#Expiration Date:
(9.) Septage Management Firm Operator Training Completed: 05720|20O_Location: tual Hours:_
Training Sponsored or Provided byACDE G DUDm.
(10.) Septage Land Application Site Operator Training Completed:
Date Location: Hours
Training Sponsored or Provided by
(11.)Registration type requested: CHECK ONE
Registered Portable Sanitation Firm
Registered Septage Management Firm: V
Registered Portable Sanitation and Septage Management Firm
Certification Statement
I certify that the infomation and representations in this application for a permit are true, complete, and accurate to the best
of my knowledge and belief. I am aware that a permit may be suspended or revoked upon a finding that its issuance was
based upon incomect or inadequate infomation that materially affected the decision to issue the permit and that there are
criminal penalties for knowingly making a false statement, representation, or certification.
A lcAed) 8/31/21 Signature (Signature of companyoficial required) Date
lso Kosacto wnae Print Name Tide
Other Comments:
Rev. 04-26-2021
PAGE 2
NC SEPTAGE MANAGEMENT FIRM
Recertification of Pumper Vehicle(s)
Septage Firm Permit #
Number of Pumper Vehicles:
NCS OI S8|
CERTIFICATION:
"I certify, under penalty of law, that the pumper vehicle or vehicles listed in the
submitted permit application meet the requirements for safe and sanitary
transportation of septage as required by15A NCAC 13B .0844 (a) and vehicle
lettering as required by 15A NCAC 13B .0844 (b). I also certify that a log is
maintained of each septage pumping event as required by 15A NCAC 138 .0839
(a). Iam aware that there are significant penalties for false certification including
the possibility of fine and imprisonment."
ala q-13-1
Signature (Signature of company officialrequired) Date
Nelson hosodo 9-13- Print Name Tide
S:1Solid WastelclalseptagelformsiPumper Vehicles Cetitication.doc
PAID
FIRM NAME: Future Adobe, Inc. DBA Charlotte Septic Inspections
PERMIT #: NCS-01581
AMOUNT: $550
PAID BY: Check
DATE: 9/27/2021
Adam Ulishney